dementia treatment research update 2019 · dementia treatment research update 2019 dr. jared r....
TRANSCRIPT
![Page 1: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/1.jpg)
Dementia TREATMENT Research Update 2019
Dr. Jared R. Brosch, M.D., M.Sc.Associate Professor of Neurology
Associate Program Director Neurology ResidencyIndiana Alzheimer’s Disease Center
Do Not Replicate without Permission
![Page 2: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/2.jpg)
• Disclosures– Dr. Brosch receives support from the following companies for
dementia clinical trial work:• Abbvie• Accera• Axovant• Avanir• Biogen • C2N/Abbvie• Eisai• Eli Lilly• Genentech• Roche• Lundbeck• Chase Pharmaceuticals• TauRx
– I use images in this presentation that are freely available and give credit with URLs to the image
![Page 3: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/3.jpg)
• Objectives
– Lifestyle Hot Topics– Alzheimer’s drug development– Other Neurodegenerative diseases
![Page 4: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/4.jpg)
https://hhp-blog.s3.amazonaws.com/2017/06/iStock-516447314.jpg
![Page 5: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/5.jpg)
• Three Major Studies Show Lifestyle Matters!!
https://images.agoramedia.com/everydayhealth/gcms/Why-the-Mediterranean-Diet-Could-Save-Your-Life-722x406.jpghttp://c1.thejournal.ie/media/2014/06/shutterstock-147680771-390x285.jpghttps://scx1.b-cdn.net/csz/news/800/2017/cognitivecro.jpghttps://www.medicalnewstoday.com/content/images/articles/323/323252/glass-of-wine.jpghttps://upload.wikimedia.org/wikipedia/commons/thumb/6/6b/No_Smoking.svg/2000px-No_Smoking.svg.png
![Page 6: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/6.jpg)
• Three Major Studies Show Lifestyle Matters!!
https://images.agoramedia.com/everydayhealth/gcms/Why-the-Mediterranean-Diet-Could-Save-Your-Life-722x406.jpghttp://c1.thejournal.ie/media/2014/06/shutterstock-147680771-390x285.jpghttps://scx1.b-cdn.net/csz/news/800/2017/cognitivecro.jpghttps://www.medicalnewstoday.com/content/images/articles/323/323252/glass-of-wine.jpghttps://upload.wikimedia.org/wikipedia/commons/thumb/6/6b/No_Smoking.svg/2000px-No_Smoking.svg.png
• 2.5 hours a week of moderate intensity exercise.
• 20-30 minute blocks of time• Brisk walk• Elliptical• Recumbent bike• Zoomba• Pickleball• Any activity that gets heart rate elevated
for 20-30 minutes• Some reports that FAR LESS than 50% of
all those over 60 years of age achieve this goal.
![Page 7: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/7.jpg)
• Three Major Studies Show Lifestyle Matters!!
https://images.agoramedia.com/everydayhealth/gcms/Why-the-Mediterranean-Diet-Could-Save-Your-Life-722x406.jpghttp://c1.thejournal.ie/media/2014/06/shutterstock-147680771-390x285.jpghttps://scx1.b-cdn.net/csz/news/800/2017/cognitivecro.jpghttps://www.medicalnewstoday.com/content/images/articles/323/323252/glass-of-wine.jpghttps://upload.wikimedia.org/wikipedia/commons/thumb/6/6b/No_Smoking.svg/2000px-No_Smoking.svg.png
• Mediterranean Style Diet• VEGETABLE based diet• DE-EMPHASIZE: red meat, butter,
cheese, pastries, sweets, simple carbs• Healthier protein choices – vegetable
protein, fish/chicken• Mixed nuts• Legumes• Healthy oils – olive oil
![Page 8: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/8.jpg)
• Three Major Studies Show Lifestyle Matters!!
https://images.agoramedia.com/everydayhealth/gcms/Why-the-Mediterranean-Diet-Could-Save-Your-Life-722x406.jpghttp://c1.thejournal.ie/media/2014/06/shutterstock-147680771-390x285.jpghttps://scx1.b-cdn.net/csz/news/800/2017/cognitivecro.jpghttps://www.medicalnewstoday.com/content/images/articles/323/323252/glass-of-wine.jpghttps://upload.wikimedia.org/wikipedia/commons/thumb/6/6b/No_Smoking.svg/2000px-No_Smoking.svg.png
• Cognitive Exercise• 20-30 minutes a day• NOT TV WATCHING• Many studies used computer based
games• No clear evidence on what is best• Social activity may count!• Crosswords, Sudoku, Word finds,
workbooks• Art projects
![Page 9: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/9.jpg)
• Three Major Studies Show Lifestyle Matters!!
https://images.agoramedia.com/everydayhealth/gcms/Why-the-Mediterranean-Diet-Could-Save-Your-Life-722x406.jpghttp://c1.thejournal.ie/media/2014/06/shutterstock-147680771-390x285.jpghttps://scx1.b-cdn.net/csz/news/800/2017/cognitivecro.jpghttps://www.medicalnewstoday.com/content/images/articles/323/323252/glass-of-wine.jpghttps://upload.wikimedia.org/wikipedia/commons/thumb/6/6b/No_Smoking.svg/2000px-No_Smoking.svg.png
• No smoking• Enough said• Probably affects cognition through
vascular disease• Potent known vascular risk factor
![Page 10: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/10.jpg)
• Three Major Studies Show Lifestyle Matters!!
https://www.medicalnewstoday.com/content/images/articles/323/323252/glass-of-wine.jpghttps://cdn.prod-carehubs.net/n1/802899ec472ea3d8/uploads/2018/02/an-illustration-of-equivalent-amounts-of-beer-hard-alcohol
• Zero or Moderate Alcohol consumption• Don’t start drinking now• If you do, limit to ONE DRINK per night• If you skip a few nights, try not to “catch
up” for the week• No safe known amount of alcohol for
the body/brain• Seems to have some cardiovascular
benefit in low amounts, perhaps may help with cerebrovascular blood flow
• AREA OF UNCERTAINTY
![Page 11: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/11.jpg)
• Three Major Studies Show Lifestyle Matters!!– FINGER STUDY
• Finnish Geriatric Intervention Study, 1300 people• 25% improvement in test scores, could delay onset and
reduce burden of AD– UK STUDY
• 200,000 adults >60yrs of age• 32% reduction in risk of dementia over 8 years
– RUSH STUDY• 2000 people• 60% reduction in rate of developing AD over 6-9 years in
people who adopted all lifestyle changes REGARDLESS OF GENETIC RISK PROFILE!!!
https://jamanetwork.com/journals/jama/article-abstract/2738355?guestAccessKey=c635f7cd-e7f5-4956-85f1-71950acad390&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=071419https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60461-5/fulltexthttps://www.aarp.org/health/dementia/info-2019/healthy-lifestyle-alzheimers.html
![Page 12: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/12.jpg)
• Drug Development Update– Approved Drugs WORK
• Donepezil (Aricept)• Rivastigmine (Exelon)• Galantamine (Razadyne)• Memantine (Namenda)
– NOT MEMORY ENHANCERS– Slow progression of Alzheimer’s and prevent need
for nursing home placement by YEARS
![Page 13: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/13.jpg)
• NEW Drug Development Update
https://www.orthocuban.com/2016/08/continuing-debate-over-scientific-research/
![Page 14: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/14.jpg)
• Drug Development Update• 2015 Data
https://browzine.com/articles/54105797
![Page 15: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/15.jpg)
• Drug Development Update
http://www.neurology.org/content/69/9/E8/F1.large.jpg
http://www.nature.com/gim/journal/v10/n4/images/gim200836f2.jpg
Intracellular TAUExtracellular AMYLOID
![Page 16: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/16.jpg)
• Drug Development Update– Amyloid Hypothesis graph
https://www.nature.com/articles/d41586-018-05718-5
![Page 17: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/17.jpg)
• Drug Development Update– Amyloid Passive Vaccination
• Caused meningoencephalitis!– Anti-Amyloid monoclonal antibodies
• Bapineuzumab (brain hemorrhages)• Solanezumab (still in 2 active studies)• Gantanerumab (in 1 active study)• Crenuzumab (in 1 active study)• Aducanumab (terminated?)• BAN2401 (in 2 active studies, and potentially 2 more)• Donanemab (in 1 active study)
https://www.nme.com/blogs/nme-blogs/terminator-6-dark-fate-release-date-cast-trailer-2451500
![Page 18: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/18.jpg)
• Drug Development Update– Picture of Amyloid molecules showing soluble,
insoluble, monomers, polymers
https://www.bioarctic.se/en/alzheimers-disease-2541/
SolanezumabCrenezumab
GantenerumabDonanemabBapineuzumab
AducanumabBAN2401
![Page 19: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/19.jpg)
• Drug Development Update
https://www.bioarctic.se/en/alzheimers-disease-2541/
![Page 20: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/20.jpg)
• Drug Development Update– Aducanumab Announcement Oct 22, 2019
• Futility analysis led to cessation of all trials in 2019• As all data was collected the following was found:
– EMERGE – MET PRE-SPECIFIED PRIMARY END-POINT!!!» HIGH dose group only. CDR 23% better (reduction in
clinical decline) in treatment than placebo, MMSE 15%, ADAS-Cog 27%, ADCS-ADL 40%.
» Amyloid plaque burden reduced, Tau levels in spinal fluid also changed
– ENGAGE – early terminated, but patients who received sufficient exposure to high dose had similar findings
https://www.medpagetoday.com/neurology/alzheimersdisease/82865
![Page 21: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/21.jpg)
• ADUCANUMAB
https://www.nature.com/articles/nature19323
![Page 22: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/22.jpg)
• Drug Development Update– Aducanumab Announcement
• Side Effects– ARIA-E
» Amyloid Related Imaging Abnormalities – Edema• Leads to headaches• Swelling of small areas of brain on MRI scan• Few to no symptoms clinically other than headache• Resolves spontaneously in 4-16 weeks• Most without any long-term issues
https://www.quora.com/What-is-ARIA-E-And-how-does-amyloid-beta-and-tau-immunotherapy-all-relate-to-it
![Page 23: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/23.jpg)
• Drug Development Update– Aducanumab Announcement Oct 22, 2019
• So many things to think about!– First – AWESOME– Second – Who pays? Will this BREAK MEDICARE?– How will people be deemed eligible? Will we need expensive
PET scans to be approved to?– Complicates further clinical trials because now this becomes
the standard of care? – Negative Amyloid PET scans?– Lastly - AWESOME
https://www.bioarctic.se/en/alzheimers-disease-2541/
![Page 24: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/24.jpg)
• Drug Development Update– Secretase inhibitors
https://www.mybraintest.org/2013/lilly-kills-a-bace-inhibitor-trial-for-alzheimers/
![Page 25: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/25.jpg)
• Drug Development Update– Secretase inhibitors
• Gamma– Furthest along was semagecestat (Lilly) – Phase 3– No improvements in cognition, increased infections and rate of
skin cancer– TERMINATED
• Beta (BACE)– Proven in SEVERAL studies to MAKE COGNITION WORSE, no other
significant side effects– Theoretical issues with retinal depigmentation and skin
depigmentation but not seen in humans– Outstanding question is that these may be viable drugs with
lower amount of secretase inhibition, but cold feet
![Page 26: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/26.jpg)
• Drug Development Update– Tau Drugs
![Page 27: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/27.jpg)
• Drug Development Update– Tau Drugs
![Page 28: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/28.jpg)
• Drug Development Update– Tau Drugs
• Anti-Tau monoclonal antibodies– Most in Phase 2– Stopped early in one study in Progressive Supranuclear palsy
(a Tau based disease)– Data slowly emerging in the next year
• Tau passive immunization• Anti-sense Oligonucleatides (ASO) against Tau
![Page 29: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/29.jpg)
• Drug Development Update– Other Drugs
• Phosphodiesterase Inhibitors• Coconut Oil Derivatives• Riluzole derivative• Diabetes drugs (RAGE)• Drugs affecting the Gut Microbiome• Drugs affecting Inflammation• Drugs targeting Immune cells in the Brain• Seizure drugs• Deep Brain Stimulation• Transcranial Magnetic Stimulation• ETC!
![Page 30: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/30.jpg)
• Drug Development Update– Other Drugs
• Phosphodiesterase Inhibitors• Coconut Oil Derivatives• Riluzole derivative• Diabetes drugs (RAGE)• Drugs affecting the Gut Microbiome• Drugs affecting Inflammation• Drugs targeting Immune cells in the Brain• Seizure drugs• Deep Brain Stimulation• Transcranial Magnetic Stimulation• ETC!
https://ars.els-cdn.com/content/image/1-s2.0-S2352873717300379-gr1_lrg.jpg
![Page 31: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/31.jpg)
• BEYOND Alzheimer’s disease– Many other neurodegenerative diseases exist and
need support!
http://tbrnewsmedia.com/medical-compass-parkinsons-disease-reducing-risk-and-slowing-progression/https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwii1eOHhbHlAhUET6wKHUVnCEoQjRx6BAgBEAQ&url=https%how-stroke-overview&psig=AOvVaw3qE4v1qjpevEUucHcXtdpg&ust=1571873984490151
![Page 32: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/32.jpg)
Dementia
Alzheimer’sDementia
Parkinson’s Disease Dementia
LewyBody Dementia
Fronto-Temporal Lobar Dementia
Progressive SupranuclearPalsy/CorticobasilarDegeneration
Vascular Dementia
Multiple Systems Atrophy
Many Others!
![Page 33: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/33.jpg)
Dementia Neuropathology
Tauopathies
• PSP• CBD• FTLD with Parkinsonism
(Chr17 – MAPT)• Pick’s Disease
Alpha-Synucleinopathies
• Parkinson’s Disease• Lewy-body
Dementia• Multiple Systems
Atrophy
Amyloid-beta/Tau
• Alzheimer’s disease
• FTLD several forms including:• FTD-ALS C9ORF72 (12/25%) familial (TDP-)• FTD Progranulin (Also Chr17) (TDP+)• FTD-FUS (Fused in Sarcoma) (TDP-)
Other
![Page 34: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/34.jpg)
• BEYOND Alzheimer’s disease– Vascular dementia is #2!
• Can be caused by multiple strokes, or from an accumulation of small blood vessel damage.
• Similar to what is seen in End Stage Multiple sclerosis• Significant gait impairment, bladder dysfunction, severe
slowing of thought process/motor systems.• “Step-Wise” decline – often have abrupt changes in
functionality that don’t improve.• Treat risk factors, keep active• Local Stroke Support Groups (Community, RHI, Franciscan,
etc)
![Page 35: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/35.jpg)
• BEYOND Alzheimer’s disease– Lewy Body Dementia’s
• Parkinson’s disease dementia + Dementia with Lewy bodies
• Hallucinations (starts with visual), Dream Enactment, BIG fluctuations in attention/alertness
• TRADE-OFF’s – treat the Parkinson’s part (worse thinking), treat the hallucinations (worse Parkinsons).
• Profound response to Cholinesterase Inhibitors• Shorter life-span (dementia + mobility/falls!)
![Page 36: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/36.jpg)
• BEYOND Alzheimer’s disease– Lewy Body Dementia’s
• Clinical Trials– 5HT6 drugs (terminated)– 5HT2A drugs (terminated)– Phosphodiesterase Inhibitors (recruiting)– D1PAM drug (recruiting)
• Rock Steady Boxing, The Climb• Local DLB Support Group (Zionsville)
https://consultqd.clevelandclinic.org/research-collaborative-launched-to-advance-progress-against-lewy-body-dementia/
![Page 37: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/37.jpg)
• BEYOND Alzheimer’s disease– Frontotemporal Dementia
• Language Presentation• Behavioral Presentation
– Young, loss of social etiquette, can be difficult to manage in memory care
– Supportive treatments only, other drugs may worsen
• FTD Support Group (Joy’s House)• NEW clinical Trials – Phase 1 – MUST KNOW GENETIC
STATUS!
![Page 38: Dementia TREATMENT Research Update 2019 · Dementia TREATMENT Research Update 2019 Dr. Jared R. Brosch, M.D., M.Sc. Associate Professor of Neurology Associate Program Director Neurology](https://reader033.vdocument.in/reader033/viewer/2022042917/5f5c3747e1cdb929361537fc/html5/thumbnails/38.jpg)
• Questions?